The efficacy of acupuncture as a nonpharmacological therapy for autism spectrum disorder (ASD) has been increasingly studied. To evaluate the current research methodologies and outcome measures in randomised controlled trials (RCTs) of acupuncture for ASD, we systematically searched eight major databases for relevant Chinese and English language literature published between 1 January 2015 and 31 December 2024. A total of 31 relevant studies were included in the literature review. Studies on acupuncture interventions for ASD were categorised into two- or three-arm designs, primarily employing indirect controls. Interventions predominantly utilised head acupoints for 12 weeks, and the acupuncture techniques were mainly tonifying and reducing techniques with moderate stimulation. Outcome indicators (n = 37) were categorised into six domains, selected a total of 111 times: symptoms and signs (59.46 %), physical and chemical test indicators (20.72 %), quality of life (8.11 %), safety events (7.21 %), functional status (2.70 %), and Chinese medical symptoms/syndrome (2.70 %). The Childhood Autism Rating Scale had the highest reporting rate among the indicators (23.24 %). Measurements were predominantly performed before treatment, post-treatment, and at the 12-week follow-up visit. Current evidence from RCTs on acupuncture for ASD is limited, restricting the clinical implementation of acupuncture protocols. Future high-quality studies should focus on standardising clinical trial designs, minimising bias, establishing consensus-driven outcome measurement selection, and developing a core outcome set for acupuncture in patients with ASD. These steps are essential for enhancing the methodological rigor and clinical relevance of acupuncture research in ASD.